Applauding CMS Move to Real Meaningful Use

RDDeborah L. Benzil, MD, FACS, FAANS, AANS (right)
Chair, AANS/CNS Communications and Public Relations Committee
Mount Kismo Medical Group
Columbia University Medical Center
Mt Kisco, New York
Rachel Groman, Vice President, Clinical Affairs and Quality Improvement (left)
Hart Health Strategies

“We have to get the hearts and minds of physicians back…I think we’ve lost them.”
-Andy Slavitt

This image was drawn by a 7 year old and illustrates her experience in the doctor’s office. Photo credit: JAMA article - JAMA. 2012;307(23):2497-2498. doi:10.1001/jama.2012.4946.

This image was drawn by a 7 year old and illustrates her experience in the doctor’s office. Photo credit: JAMA article – JAMA. 2012;307(23):2497-2498. doi:10.1001/jama.2012.4946.

The AANS, CNS and all of neurosurgery applaud the important steps announced by the Centers for Medicare & Medicaid Services (CMS) in transforming EHR incentives for the benefit of our patients and quality patient care. Creating reasonable regulations for true meaningful use of electronic health records (EHR) has been a high priority for neurosurgery and all of organized medicine for many years. Recently, CMS announced its intent to use the Medicare Access and CHIP Reauthorization Act (MACRA) as an opportunity to shift away from what has been a deeply flawed strategy of incentivizing “meaningful use” of EHRs. Ongoing barriers persist, and we are hopeful that this change in strategy will help to address the current lack of specialty-relevant functionalities and measures, as well as interoperability, which continues to impede the meaningful use of these technologies.

Before any of this can succeed, CMS must ensure that EHR systems resolve essential cornerstones necessary for data exchange including:

  • Development of standardized data elements;
  • Addressing barriers related to privacy and security; and
  • Minimizing data blocking.

CMS must focus primarily on increasing the functional interoperability between vendors and among vendors and registries before holding physicians accountable for these activities. Unfortunately, the current federal “certification” process often limits the potential utility of EHR technology by constraining functionality to accommodate specific measurements, calculations, and arbitrary thresholds.

Since meaningful use is a significant component of MACRA’s Merit-based Incentive Payment System (MIPS) — accounting for 25 percent of a physician’s total performance score — it is critical that CMS make changes to refocus the program and to ensure that meaningful use is achievable and useful for all physicians, including specialists. The current pass-fail nature of the program fails to recognize the diversity of clinical practices and patient populations and is just unsustainable. Going forward, physicians should have the flexibility to demonstrate meaningful use in an accumulative fashion, receiving points for incremental efforts that are most relevant to their practice.

It is equally critical that meaningful use measures be redesigned to focus on clinically relevant information, rather than processes and data entry. Rather than emphasizing counting and thresholds, measures should focus on whether data is accessible and usable. As part of this process, we urge CMS to recognize better physician participation in a clinical data registry as an activity that supports the goals of meaningful use. CMS also should collaborate with national specialty societies to develop health IT-enabled alternatives or pilots that could be optionally used to satisfy the meaningful use component of the MIPS composite score.

In the future, meaningful use should continue to provide protections so as not to penalize physicians based on circumstances largely beyond their control — such as subspecialty/scope of practice, location/setting, health information exchange (HIE) network availability, and patient population.

Organized neurosurgery has and will continue to work with CMS to offer insights on how to create a meaningful interoperable system that benefits patients and quality patient care.

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Face of Neurosurgery: Dr. Karin Muraszko a Unique and Remarkable Neurosurgeon

parrAnn M. Parr, MD, PhD
Assistant Professor, Department of Neurosurgery
University of Minnesota
Minneapolis, MN

Anyone who has ever met, worked with, or been trained by Karin M. Muraszko, MD, knows how incredibly special she is. Now her remarkable talents and accomplishments will be rightly shared with a far wider audience. On Jan. 24, 2016, CNN aired, The Person Who Changed My Life,” a two-hour special during which CNN’s anchors and correspondents took viewers on in-depth, revealing, and emotional journeys to meet the heroes of their lives.

One featured hero was Dr. Murasko, a renowned neurosurgeon.

Dr. Murasko mentored Dr. Sanjay Gupta, CNN’s Chief Medical Correspondent, during his seven-year neurosurgical residency at the University of Michigan Health System, and is the first (and is still the only one) woman to become a neurosurgery department chair in the United States, steering the Department of Neurosurgery at the University of Michigan Health System since 2005. One of the largest in the country, the department houses a small army of neurosurgeons and multiple research faculty members who work together to treat the entire spectrum of neurosurgical diseases with state of the art interventions. From the youngest to the oldest, her team works to treat patients with disorders such as severe traumatic injuries, brain tumors, congenital malformations, peripheral nerve disorders and much more.


Photo Credit: Picture taken from Dr. Sanjay Gupta’s Twitter Account

Dr. Muraszko was born with spina bifida, a condition that prevents the spine from properly developing. As a result, she has had difficulty walking, making her accomplishments even more noteworthy. According to Dr. Gupta, “she never spent a lot of time talking about it. Instead, she came into the hospital earlier, stayed later and worked harder than everyone else. And that is saying something, because Karin is a pediatric neurosurgeon, a profession that required 100-hour work weeks during her training.”

Dr. Muraszko was also one of a few pioneers who established Women In Neurosurgery (WINS) in 1990.  She was the third president of WINS and, since its inception, she has served continuously on the WINS Executive Board — providing extraordinary mentorship and guidance to other women in neurosurgery for more than 25 years. In addition to being the first woman neurosurgical department chair, she has the distinction of being the first woman to serve on the American Board of Neurological Surgeons and the Residency Review Committee for Neurological Surgery.

As Dr. Gupta aptly put it, “we all need someone like Karin in our lives,” someone who believes in us and shows us that nothing is impossible. As people watch CNN’s special (video embedded below), it is my hope that they see Dr. Muraszko not only as the individual who changed Dr. Gupta’s life but also how she changed the lives of her countless patients and future generations of neurosurgeons.

Dr. Karin Muraszko is one of the truly unique and remarkable faces of neurosurgery and along with CNN, we applaud her many accomplishments.


Posted in Faces of Neurosurgery, Guest Post, Health | Tagged , , , , , , , , , , |

Healthcare Leaders: What Our Patients Need

benzilGuest Post from Deborah L. Benzil, MD, FACS, FAANS
Vice President, AANS
Chair, AANS/CNS Communications and Public Relations Committee
Columbia University Medical Center
Mt Kisco, New York

Recently, Becker’s Spine Review tweeted a story entitled, “13 Healthcare Leaders Named Best Performing CEOs.” The rankings from this piece are from Harvard Business Review and are based on stock market number, total shareholder return and the change in each company’s market capitalization (80 percent). In addition, a measurement of environmental, social and governance performance was included (20 percent).

healthcareaAs a neurosurgeon working hard to provide high quality care to my patients in a practice environment that is ever more challenging, I smiled at the thought that healthcare leaders ranked at the top of the business world. Imagine the shock when I actually read the fine print (a detail I fear too many omit).  Let us consider some of these businesses and what they have contributed to patient care improvement in recent years.

Six of the companies primarily work in the arena of pharmaceuticals. Physicians and their patients rely on the investment of such companies to develop and provide a wide spectrum of medications to treat many acute and chronic medical conditions. Clearly for these companies, that investment has reaped extremely high financial rewards. Three additional companies manufacture equipment or supplies to the healthcare industry, items such as catheters and dialysis equipment. Much like pharmaceuticals, these items are important and in the hands of capable CEOs, can be wildly profitable.

Rounding out the list, however, are four companies that raised considerable ire. First and foremost was the presence of Aetna. Despite regulatory efforts to the contrary, our rapidly escalating insurance premiums are benefiting corporate executives and shareholders, rather than patients! Next on this hit parade is Express Scripts, self-described as the largest pharmacy benefit management organization in the U.S. Much like with Aetna, this company takes premium dollars paid by individuals and then controls the flow of those dollars into required medications. They claim to make the use of prescription drugs safer and more affordable. Certainly that might be true, but they, too, are generous to those treating this strictly as business in a big profit way.

Finally, there are McKesson (imaging platforms) and Cerner (electronic health records), which both provide technological solutions that should make healthcare delivery safer and more efficient. Sadly, as most physicians will attest, these systems (along with their partners in crime such as Epic, NextGen, Carestream, and Fuji) are poorly designed, limited in functionality, and far behind in meeting even the basic interchangeability goals that could mean real benefit to patient care. Is it reasonable to suggest — given the enormous amount of federal support provided for these systems development — that these companies answer to the needs of patients and physicians, not the other way around.

As those in healthcare are struggling hard to meet the important challenge of providing “value” in patient care, there remain those on the business side of this service who are allowed to reap enormous profits and then are honored for the successes of their business acumen.  This highlights the conundrums U.S. healthcare faces:

  • Who deserves investment and reward within the arena of healthcare providers (physicians, nurses, therapists, etc.) or administrators and business people who provide no direct or indirect patient care?
  • Do patients derive benefit from the significant, durable high profits that have been realized by these companies?

We struggle with these complex issues facing healthcare delivery today. The quality of our healthcare system cannot be sustained without honoring and rewarding those who spend years learning the science and art of providing direct patient care. Supplying the support and infrastructure for healthcare providers to ensure optimal quality and value through technology (think EHR) and business acumen is essential and should be both encouraged and acknowledged. Physicians stand ready to work with these companies to bring real benefit to our patients.

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